A bruise is one of the
most common sports injuries. Typically, it is a collection
of blood under the skin that heals quickly when treated
with R.I.C.E (Rest, Ice, Compression, Elevation) and
pain medication. However, sometimes a bruise can be
a sign of deeper trauma. If left untreated, some large
bruises may even wind up causing permanent muscle damage.
According to Matthew
D. Maddox, D.O., team physician for the Phoenix
Coyotes, bruises can be divided into several categories.
Understanding the symptoms and basic treatment of each
type of bruise will help you know when your bruises
are serious enough to need a physician’s care.

Extramuscular
Bruises — The most common type of bruise is a
collection of blood just below the skin, which appears
rapidly after a collision or trauma. Extramuscular bruises
can be large and serious looking, but they usually heal
quickly with standard R.I.C.E. (Rest, Ice, Compression,
Elevation) treatment.

Intramuscular
Bruises — Some trauma can cause an area of blood
to collect inside a muscle, which may interfere with
a muscle’s function and restrict your ability
to move.

Intermuscular
Bruises — Blood can also collect between layers
of muscle without actually spreading into the muscle
itself. Intermuscular bruises can also limit your movement.

Deep
Bruises — This term refers to any bruise that
results in a significant amount of blood collecting
in and around muscle tissue. More blood collecting in
the muscle tissue causes greater pain. Severe deep bruises
can be any combination of extra, intra, and intermuscular
bruises. Blood may collect from directly under the skin,
into the underlying muscle tissues, and throughout the
space between muscle.

After a direct contact or a twisting injury, such as
an ACL tear, an athlete may have a bruise on the bone
itself. “You can get swelling and injury to the
bone without actually breaking the bone,” says
Dr. Maddox. Though bone bruises usually heal on their
own, a small percentage can cause joint problems or
fractures. The more concentrated a bone bruise is, the
more of a problem it causes. “It is like if you
took a hammer and struck one tiny spot versus hitting
a big, broad area – more force is distributed
over a wider area,” says Dr. Maddox.

Causes

Muscle According to Dr. Maddox, deep
bruises occur most often in the thighs and arms during
contact sports like soccer, rugby, and martial arts
where athletes do not wear thigh or arm pads. Football
and hockey players also frequently suffer deep bruises,
despite the use of protective equipment. Bone Another
type of bone bruise occurs when the covering of the
bone, called the periosteum, is injured. The periosteum
is a special connective tissue covering all the bones
in the body that possesses the ability to form new bone
tissue. Periosteum bone bruises are often seen in football
players after repetitive hits to the shoulder. Right
below the shoulder pad, multiple tackles and collisions
can damage the upper arm bone’s periosteum, causing
a condition commonly called blocker’s bone. A
bone bruise to the periosteum in the upper arm may cause
bony build-up in the shoulder and a bone-spur may grow,
which restricts movement.

For all types of bruises, athletes
should treat any bruised areas with R.I.C.E. (Rest,
Ice, Compression, and Elevation) immediately after an
injury. You should ice a bruise for about 15 minutes
at a time, two or three times a day. Ice constricts
blood vessels, which slows blood flow into the area
and speeds healing time. In the rare event that a bruise,
particularly a bone bruise, is not visible, you should
still apply R.I.C.E. treatment to the area in pain.
The bruised area should be elevated above the heart
level. It should not be used for weight-bearing activity.
Gentle compression should be applied using a wrap of
neoprene or athletic tape. Anti-inflammatories or painkillers
can be used to help comfort your pain. R.I.C.E. treatment
for 24 hours should start to reduce the swelling and
pain associated with a bruise. If symptoms worsen in
24 hours, your bruise may be a sign of deeper trauma,
such as a stress fracture, and a physician should examine
it. Proper treatment of bruises is the best way to prevent
a minor injury from becoming dangerous. If a bruise
is left untreated, blood may continue to enter an injured
area. This can cause devastating complications for athletes.

PREVENTING MYOSITIS
OSSIFICANS

If a bruise spreads from the below
the skin surface into muscle tissue, athletes are at
risk of developing bone tissue build-up in their muscles.
This condition, called myositis ossificans, occurs when
excess blood flows into muscle tissue after an injury.
Instead of healing as scar tissue, the healing process
ossifies the blood, turning it into bone tissue. This
greatly restricts movement. Ice and compression typically
prevent myositis, but deeper and larger bruises are
more at risk of developing myositis. Before a large
bruise becomes too stiff, you should have it evaluated
by a physician. According to Dr. Maddox, you should
have a physician check your bruise if:

you
are having trouble bending your knees, elbows, or other
joints further than 90 degrees

the
pain is getting worse or staying the same after 24 hours
of R.I.C.E. treatment

weight-bearing
activity is difficult

Physicians can more easily help you prevent myositis
if you seek treatment before bone tissue starts to form.

If you
take too much pain medication, you are more prone to
suffering compartment syndrome. According to Dr. Maddox,
a high dose of anti-inflammatory medications like aspirin
or Advil makes the platelets that coagulate your blood
less sticky. If you suffer a bruise, it may continue
to bleed, causing a build-up of blood in the thigh or
arm. If the blood exerts enough pressure, you can develop
a compartment syndrome, which is a rare emergency situation
requiring a surgeon to open up the bruised area to relieve
the pressure. To prevent compartment syndrome, you must
immediately recognize these symptoms:

increasing
pain

skin
pallor, a noticeable loss of color

inability
to feel a pulse in the arteries of the bruised extremities

a
tingling sensation in the fingers and toes that increases
despite treatment with ice and compression – tingling
may be a sign that you are losing circulation and need
to see a physician immediately.

“There is only so much space in your arm,”
says Dr. Maddox. “If it is all filling up with
blood, it puts pressure on the nerves and vessels in
there, and it is just like putting a tourniquet around
your limb.” In extreme situations, this can put
you at risk for losing a limb.